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HCS and TxHmL Waiver Programs: Trending Issue Support, Volume 18

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Since May 2, 2022, Home and Community-based Services (HCS) and Texas Home Living (TxHmL) program providers, local intellectual and developmental disability authorities (LIDDAs), and financial management services agencies (FMSAs) billing on behalf of consumer-directed services (CDS) have been submitting claims and forms to the Texas Medicaid & Healthcare Partnership (TMHP). TMHP has received feedback from providers and LIDDAs indicating that additional support is required. Resolutions regarding the most frequently reported issues are presented in the table below.

Topic

Resolution

Client on Hold Removal

The following list describes the types of holds and how to remove them:

  • Intellectual Disability Related Condition (IDRC) Timeliness Penalty (TP1) Hold: The IDRC was initiated by a late submission. The provider needs to submit a Purpose Code E (PCE) to release the hold. If the hold is for a client who has only CDS services, the LIDDA needs to submit the PCE. Refer to the 8578 Intellectual Disability/Related Condition PC E Gaps in Assessment section of the LTC HCS and TxHmL Waiver Programs Provider User Guide for instructions on submitting this form.
  • Individual Plan of Care (IPC) Timeliness Penalty (TP2) Hold: The IPC was initiated by a late submission. To remove the hold, contact the HCS/TxHmL Utilization Review (UR) Message Line at 512-438-5055.
  • Suspension Reason (or Review) Hold: There is an Individual Movement (IMT) Suspension or a 3615 Continuation of Suspension in place. To release the hold, return the individual to service. Refer to the Individual Movement Form—Suspension of Waiver Services Request or the 3615 Request to Continue Suspended Services, Return to Service Process sections, of the LTC HCS and TxHmL Waiver Programs Provider User Guide for instructions on returning an individual to service.

Note: When returning an individual to service, the provider or LIDDA will need to use the 3615 form if there is one on file after the IMT Suspension. For individuals who do not have a 3615 form after the IMT Suspension, the return to service function on the IMT Suspension form should be used.

  • ID CARE (IDC) Hold: There is no suspension on the LTC Online Portal, so the provider cannot return the individual to service. Contact the HCS/TxHmL UR Message Line at 512-438-5055.

View a List of All Clients on Hold Through the Dashboard

Providers can view a list of all clients on hold by using the LTC Online Portal (OP) Dashboard. Refer to the Assigning Permissions & Accessing the LTCOP Dashboard video in the HCS and TxHmL YouTube playlist. Providers can also refer to the Dashboard section of the LTC HCS and TxHmL Waiver Programs Provider User Guide for more information on how to view information for individuals, including hold details.

HHSC Will Accept Current IPC Form with Handwritten ISS

The Texas Health and Human Services Commission (HHSC) is aware that the current printable IPC form on the HHSC website does not include Individualized Skills and Socialization (ISS) services to replace day habilitation. Providers and LIDDAs can handwrite the ISS service on the form, and HHSC will accept the form.

Common Claim Rejections and Steps to Avoid Rejections

HCS and TxHmL providers and LIDDAs might see one of the following explanation of benefits (EOBs) when a claim is rejected:

Explanation of Benefits

Description

F0077

Billing Code was not submitted or cannot be determined.

F0138

A valid Service Authorization for this client for this Service on these dates is not available.

To avoid having claims rejected, HCS and TxHmL providers should do the following before submitting claims to TMHP:

1. Check the TexMedConnect Medicaid Eligibility Service Authorization Verification (MESAV) for client service authorization, level, client hold, and eligibility information. The following client information should be verified:

  • Services authorized for the client
  • Service dates authorized for the client
  • Levels authorized for the client   

2. Use the HCS and TxHmL Bill Code Crosswalks to check for important claims information, such as the Line Item Control Number (LICN).   

Chapters Added to YouTube Videos

Chapter links have been added to the videos in the HCS and TxHmL YouTube playlist. This allows viewers to jump directly to specific sections of each video to find the information they need.

To access the chapter links, follow these steps:

  1. Open the video from the playlist.
  2. Under the video title is a collapsed section that contains a description of the video. You can expand the description section by selecting Show more if you are using a web browser, or select more if you are using a mobile YouTube app.
  3. At the bottom of the expanded description section, the list of chapters will be shown as thumbnails with timestamps and titles. Select a chapter, and the video will start playing from that point.

View previous postings below:

HCS and TxHmL Waiver Programs: Trending Issue Support, Volume 17

HCS and TxHmL Waiver Programs: Trending Issue Support, Volume 16

HCS and TxHmL Waiver Programs: Trending Issue Support, Volume 15

HCS and TxHmL Waiver Programs: Trending Issue Support, Volume 14

HCS and TxHmL Waiver Programs: Trending Issue Support, Volume 13

HCS and TxHmL Waiver Programs: Trending Issue Support, Volume 12

HCS and TxHmL Waiver Programs: Trending Issue Support, Volume 11

HCS and TxHmL Waiver Programs: Trending Issue Support, Volume 10

HCS and TxHmL Waiver Programs: Trending Issue Support, Volume 9

HCS and TxHmL Waiver Programs: Trending Issue Support, Volume 8

HCS and TxHmL Waiver Programs: Trending Issue Support, Volume 7

HCS and TxHmL Waiver Programs: Trending Issue Support, Volume 6

HCS and TxHmL Waiver Programs: Trending Issue Support, Volume 5

HCS and TxHmL Waiver Programs: Trending Issue Support, Volume 4

HCS and TxHmL Waiver Programs: Trending Issue Support, Volume 3

HCS and TxHmL Waiver Programs: Trending Issue Support, Volume 2

HCS and TxHmL Waiver Programs: Trending Issue Support

HCS and TxHmL Providers Must Use Bill Codes Listed in the HCS and TxHmL Bill Code Crosswalk for Claims Submission

Important Claims Submission Information for HCS and TxHmL Programs

LTC Online Portal Dashboard Accessibility Issue Resolved

IPC Forms 3608 and 8582 Issue Resolved

HCS and TxHmL FAQ Updates Available May 9, 2022, and May 23, 2022

Individual Plan of Care (IPC) Training Materials for HCS and TxHmL Waiver Programs

Now Available: HCS and TxHmL Programs Forms and Claims Submissions to TMHP

EVV Updates for the HCS and TxHmL Transition to TMHP for Claims Submission

For assistance with any further questions, contact the TMHP LTC Help Desk at 800-626-4117 (select option 1 and then option 7).